Gamma-Secretase Inhibitor RO4929097 in Treating Young Patients With Relapsed or Refractory Solid Tumors, CNS Tumors, Lymphoma, or T-Cell Leukemia

Sponsor

National Cancer Institute (NCI) (NIH)

Overall Status

Terminated

CT.gov ID

NCT01088763

Collaborator

(none)

129

Enrollment

Locations

Arm

Duration (Months)

10.8

Patients Per Site

0.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This phase I/II clinical trial is studying the side effects and best dose of gamma-secretase inhibitor RO4929097 and to see how well it works in treating young patients with relapsed or refractory solid tumors, CNS tumors, lymphoma, or T-cell leukemia. Gamma-secretase inhibitor RO4929097 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Condition or Disease	Intervention/Treatment	Phase
Childhood Atypical Teratoid/Rhabdoid Tumor Childhood Central Nervous System Choriocarcinoma Childhood Central Nervous System Germinoma Childhood Central Nervous System Mixed Germ Cell Tumor Childhood Central Nervous System Teratoma Childhood Central Nervous System Yolk Sac Tumor Childhood Choroid Plexus Tumor Childhood Craniopharyngioma Childhood Ependymoblastoma Childhood Grade I Meningioma Childhood Grade II Meningioma Childhood Grade III Meningioma Childhood Infratentorial Ependymoma Childhood Medulloepithelioma Childhood Mixed Glioma Childhood Oligodendroglioma Childhood Supratentorial Ependymoma Gonadotroph Adenoma Pituitary Basophilic Adenoma Pituitary Chromophobe Adenoma Pituitary Eosinophilic Adenoma Prolactin Secreting Adenoma Recurrent Childhood Acute Lymphoblastic Leukemia Recurrent Childhood Anaplastic Large Cell Lymphoma Recurrent Childhood Brain Stem Glioma Recurrent Childhood Central Nervous System Embryonal Tumor Recurrent Childhood Cerebellar Astrocytoma Recurrent Childhood Cerebral Astrocytoma Recurrent Childhood Ependymoma Recurrent Childhood Grade III Lymphomatoid Granulomatosis Recurrent Childhood Large Cell Lymphoma Recurrent Childhood Lymphoblastic Lymphoma Recurrent Childhood Medulloblastoma Recurrent Childhood Pineoblastoma Recurrent Childhood Small Noncleaved Cell Lymphoma Recurrent Childhood Spinal Cord Neoplasm Recurrent Childhood Subependymal Giant Cell Astrocytoma Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor Recurrent Childhood Visual Pathway and Hypothalamic Glioma Recurrent Childhood Visual Pathway Glioma Recurrent Pituitary Tumor Recurrent/Refractory Childhood Hodgkin Lymphoma T-cell Childhood Acute Lymphoblastic Leukemia T-cell Large Granular Lymphocyte Leukemia TSH Secreting Adenoma Unspecified Childhood Solid Tumor, Protocol Specific	Drug: gamma-secretase/Notch signalling pathway inhibitor RO4929097 Other: diagnostic laboratory biomarker analysis Other: pharmacological study Drug: dexamethasone	Phase 1

Detailed Description

PRIMARY OBJECTIVES:

To estimate the maximum-tolerated dose (MTD) and recommend a phase II dose of gamma-secretase inhibitor RO4929097 administered orally to children with relapsed or refractory solid tumors or lymphoma on two schedules: once daily orally on a 3-day on/4-day off weekly schedule (schedule A) or once daily for 5 consecutive days weekly schedule (schedule B).
To define and describe the toxicities of this drug administered on these schedules to children with relapsed or refractory solid tumors, lymphoma, or T-cell leukemia.
To estimate the MTD and recommended phase II dose of gamma-secretase inhibitor RO4929097 administered with dexamethasone.
To define and describe the toxicities of gamma-secretase inhibitor RO4929097 administered with dexamethasone.
To characterize the pharmacokinetics of gamma-secretase inhibitor RO4929097 in children with refractory cancer.

SECONDARY OBJECTIVES:

To preliminarily define the antitumor activity of gamma-secretase inhibitor RO4929097 in children with solid or CNS tumors and lymphoma within the confines of a phase I study.
To obtain initial efficacy data on the antitumor activity of gamma-secretase inhibitor RO4929097 when combined with dexamethasone in children with relapsed-refractory T-cell leukemia (T-acute lymphoblastic leukemia [ALL]).
To study the effect of gamma-secretase inhibitor RO4929097 on Hes1 (hairy/enhancer of split) and other components of the Notch signaling pathway in peripheral blood mononuclear cells and/or T-ALL blasts. (exploratory) IV. To examine archival tumor samples for expression of JAGGED1, JAGGED2, cleaved NOTCH1, and HES1, and HES5 by IHC and for amplification of NOTCH1 or NOTCH2 using FISH analysis. (exploratory) V. To preliminarily assess changes following treatment with gamma-secretase inhibitor RO4929097 using FDG PET imaging. (exploratory)

OUTLINE: This is a multicenter, phase I, dose-escalation study of gamma-secretase inhibitor RO4929097 followed by a phase II study. Patients are enrolled sequentially to group A or B.

GROUP B: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-5, 8-12, 15-19, and 22-26. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. Patients may also receive concurrent oral dexamethasone twice daily on the days of gamma-secretase inhibitor RO4929097 administration.

Once the MTD or recommended phase II dose of RO4929097 plus dexamethasone in children with solid tumors, including CNS tumors, or lymphoma has been identified, this dose is used for patients with relapsed-refractory T-ALL (phase 2 portion of the study) to evaluate RO4929097 in combination with dexamethasone using one of the studied schedules. Blood, plasma, bone marrow, and tumor tissue samples may be collected at baseline and periodically during the first course for correlative lab and tumor studies, including pharmacokinetics.

After completion of study treatment, patients are followed up for up to 30 days.

*NOTE: This trial was intended to be Phase I/II, but the trial never continued to the Phase II portion.

Study Design

Study Type:

Interventional

Actual Enrollment :

129 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A PHASE 1/2 STUDY OF RO4929097, AN ORAL SMALL MOLECULE INHIBITOR OF GAMMA-SECRETASE, IN CHILDREN WITH RELAPSED/REFRACTORY SOLID OR CNS TUMORS, LYMPHOMA, OR T-CELL LEUKEMIA

Study Start Date :

Mar 1, 2010

Actual Primary Completion Date :

May 1, 2011

Actual Study Completion Date :

May 1, 2011

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm I GROUP A: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-3, 8-10, 15-17, and 22-24. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. GROUP B: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-5, 8-12, 15-19, and 22-26. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. Patients may also receive concurrent oral dexamethasone twice daily on the days of gamma-secretase inhibitor RO4929097 administration. Once the MTD or recommended phase II dose of RO4929097 plus dexamethasone in children with solid tumors, including CNS tumors, or lymphoma has been identified, this dose is used for patients with relapsed-refractory T-ALL (phase 2 portion of the study) to evaluate RO4929097 in combination with dexamethasone using one of the studied schedules.	Drug: gamma-secretase/Notch signalling pathway inhibitor RO4929097 Given PO Other Names: R4733 RO4929097 Other: diagnostic laboratory biomarker analysis Correlative studies Other: pharmacological study Correlative studies Other Names: pharmacological studies Drug: dexamethasone Given IV Other Names: Aeroseb-Dex Decaderm Decadron DM DXM

Arm

Intervention/Treatment

Experimental: Arm I

GROUP A: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-3, 8-10, 15-17, and 22-24. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. GROUP B: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-5, 8-12, 15-19, and 22-26. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity. Patients may also receive concurrent oral dexamethasone twice daily on the days of gamma-secretase inhibitor RO4929097 administration. Once the MTD or recommended phase II dose of RO4929097 plus dexamethasone in children with solid tumors, including CNS tumors, or lymphoma has been identified, this dose is used for patients with relapsed-refractory T-ALL (phase 2 portion of the study) to evaluate RO4929097 in combination with dexamethasone using one of the studied schedules.

Drug: gamma-secretase/Notch signalling pathway inhibitor RO4929097

Given PO

Other Names:

R4733

RO4929097

Other: diagnostic laboratory biomarker analysis

Correlative studies

Other: pharmacological study

Correlative studies

Other Names:

pharmacological studies

Drug: dexamethasone

Given IV

Other Names:

Aeroseb-Dex

Decaderm

Decadron

DXM

Outcome Measures

Primary Outcome Measures

Maximum tolerated dose (MTD) of RO4929097 determined according to dose-limiting toxicities (DLTs) graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0) [28 days]
MTD of RO4929097 administered with dexamethasone determined according to DLTs graded using CTCAE v4.0 [28 days]

Secondary Outcome Measures

Antitumor activity of RO4929097 with or without dexamethasone assessed by Response Evaluation Criteria for Solid Tumors (RECIST) [Up to 30 days]

Eligibility Criteria

Criteria

Ages Eligible for Study:

1 Year to 21 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Histologically confirmed malignancy (at diagnosis or relapse)
Biopsy not required for intrinsic brain stem tumors or optic pathway gliomas
No B-cell precursor acute lymphoblastic lymphoma (ALL) or acute myeloid leukemia
No T-cell leukemia with CNS3 disease
Measurable or evaluable disease
Current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life
Neurologic deficits in patients with CNS tumors must have been relatively stable for 1 week
No active CNS leukemia
Karnofsky performance status (PS) 50-100% (for patients > 16 years of age) or Lansky PS 50-100% (for patients ≤ 16 years of age)
Patients who are unable to walk because of paralysis,but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the PS
Patients with solid tumors without bone marrow involvement must meet the following criteria:
Peripheral ANC ≥ 1,000/mm^3
Platelet count ≥ 100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions within the past 7 days)
Hemoglobin ≥ 8.0 g/dL (may receive RBC transfusions)
Patients with known bone marrow metastatic disease must meet the above criteria and must not be known to be refractory to red cell or platelet transfusion
Patients with leukemia must meet the following criteria:
Platelet count ≥ 20,000/mm^3 (may receive platelet transfusions)
Hemoglobin ≥ 8.0 g/dL (may receive RBC transfusions)
Must not be known to be refractory to RBC or platelet transfusions
Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR a serum creatinine based on age/gender as follows:
≤ 0.6 mg/dL (patients 1 to < 2 years)
≤ 0.8 mg/dL (patients 2 to < 6 years)
≤ 1 mg/dL (patients 6 to < 10 years)
≤ 1.2 mg/dL (patients 10 to < 13 years)
≤ 1.4 mg/dL (female patients ≥ 13 years)
≤ 1.5 mg/dL (male patients 13 to < 16 years)
≤ 1.7 mg/dL (male patients ≥ 16 years)
Bilirubin (sum of conjugated and unconjugated) ≤ 1.5 times upper limit of normal (ULN) for age
ALT ≤ 110 U/L (for the purpose of this study, the ULN for ALT is 45 U/L)
Serum albumin ≥ 2 g/dL
No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or hypokalemia defined as < lower limit of normal despite adequate electrolyte supplementation
Baseline QTc < 450 msec
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective double-method contraception (i.e., one highly effective method and one additional effective method) for ≥ 4 weeks before, during, and for ≥ 12 months after completion of study treatment
Female patients may not donate ova during or after study treatment
Able to comply with the safety monitoring requirements of the study, in the opinion of the investigator
Able to swallow tablets and capsules
No known malabsorption syndrome or other condition that would interfere with intestinal absorption
No known serological positivity for hepatitis A, B, or C, no known history of liver disease, and no other forms of hepatitis or cirrhosis
No known HIV positivity
No uncontrolled infection
No history of allergic reactions attributed to compounds of similar chemical or biologic composition to gamma-secretase inhibitor RO4929097 or dexamethasone
Patients may not donate blood during or for ≥ 12 months after completion of study treatment
No hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or hypokalemia that is uncontrolled despite adequate electrolyte supplementation
No prior gamma-secretase inhibitor RO4929097
Fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy
More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosourea) (for patients with solid tumors, CNS tumors, or lymphomas)
Patients with T-cell leukemia must meet the following criteria:
Patients who relapsed on standard ALL maintenance chemotherapy must not have received maintenance chemotherapy within the past 3 days
Patients who relapsed when they were not receiving standard ALL maintenance therapy are eligible provided it has been ≥ 14 days since the completion of cytotoxic chemotherapy with the exception of hydroxyurea
Cytoreduction with hydroxyurea can be initiated and continued for up to 24 hours before the start of study treatment
At least 6 months since prior total-body irradiation (TBI), craniospinal radiotherapy, or radiotherapy to ≥ 50% of the pelvis
At least 6 weeks since other prior substantial bone marrow radiotherapy
At least 2 weeks since prior local palliative radiotherapy (small port)
At least 3 months since prior stem cell transplantation or rescue without TBI and no evidence of active graft-vs-host disease
At least 7 days since the completion of therapy with a biologic agent
For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur (the duration of this interval must be discussed with the study chair)
At least 7 days or 3 half-lives, whichever is longer, since prior treatment with a monoclonal antibody
More than 7 days since prior growth factors that support platelet or white cell number or function
At least 7 days since prior corticosteroids
No other concurrent investigational drugs
No other concurrent anticancer agents including chemotherapy (except for hydroxyurea), radiotherapy, immunotherapy, or biologic therapy
Patients with T-ALL who benefit from treatment with gamma-secretase inhibitor RO4929097 in combination with dexamethasone may receive intrathecal methotrexate
No concurrent warfarin sodium (Coumadin®)
No concurrent medications that are strong inducers and/or inhibitors of CYP3A4
No concurrent medications or food that may interfere with the metabolism or gamma-secretase inhibitor RO4929097, including ketoconazole and fresh-squeezed grapefruit juice

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Lucile Packard Children's Hospital Stanford University	Palo Alto	California	United States	94304
2	Stanford University Hospitals and Clinics	Stanford	California	United States	94305
3	Lurie Children's Hospital-Chicago	Chicago	Illinois	United States	60614
4	Indiana University Medical Center	Indianapolis	Indiana	United States	46202
5	Dana-Farber Cancer Institute	Boston	Massachusetts	United States	02115
6	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
7	Columbia University Medical Center	New York	New York	United States	10032
8	Nationwide Children's Hospital	Columbus	Ohio	United States	43205
9	St. Jude Children's Research Hospital	Memphis	Tennessee	United States	38105
10	Baylor College of Medicine	Houston	Texas	United States	77030
11	Seattle Children's Hospital	Seattle	Washington	United States	98105
12	Hospital for Sick Children	Toronto	Ontario	Canada	M5G 1X8